关节镜下关节清理术治疗膝骨关节炎的疗效

目的：研究关节镜下关节清理术治疗膝骨关节炎的临床疗效。方法：73例膝骨关节炎患者经严格的保守治疗无效,行关节镜清理术,方法包括清理增生的滑膜和软骨游离体、修整损伤的半月板、稳定软骨缺损、切除碰撞的骨赘、成形狭窄的髁间窝以及切除囊肿等。患者术前和术后分别进行医院特别手术评分（HSS）、西Ontario和McMaster大学骨关节炎指数（WOMAC）膝关节功能评分,并评估患者年龄、症状、腔室受累情况、关节活动度以及主观满意度。结果：术后2年有效随访,并获得最终评估。73例中61例满意,5例恶化无法评估,7例接受再次手术。HSS膝关节功能评分从术前28.6改善到术后的52.4。WOMAC评分从术前40.6改善到术后的31.5。所有失败的12例患者,都有严重的屈膝孪缩（〉15°）、力线异常加重（内翻〉10°）和多腔室疾患受累（术前HSS评分平均为23.5,WOMAC评分平均为62分,术前屈膝挛缩平均为15.8°）。结论：经选择的膝骨关节炎患者,关节镜清理术治疗确能明显改善症状,获得良好的临床效果。

The Therapeutic Effect in Osteoarthritic Knees by Arthroscopic Debridement

Objective：The purpose of this study was to evaluate the therapeutic effect that arthroscopic debridement in osteoarthritic knees.Methods： A total of 73 patients with an osteoarthritis knee,who failure to the strict conservative treatment and really understand that the goal of surgery was to relieve symptoms and not to ＇cure＇,were accepted the arthroscopic debridement.Surgical treatment included debridement of synovium and osteochondral loose bodies,chipping of meniscal lesions,stabilization of chondral defects,removal of impinging osteophytes,notchplasty,and resection of Cyst.Age,symptoms,compartments involved,range of motion,and level of satisfaction were evaluated.And,the Hospital for Special Surgery（HSS） and Western Ontario and MacMaster University（WOMAC） scores were also evaluated preoperative and postoperative,respectively.Results： At 2 years available follow up,61 of 73 patients were satisfied.Five patients were impossible to evaluate for deterioration,and another 7 were considered failures requiring further surgery.Mean HSS scores improved from 28.6 to 52.4.Mean WOMAC scores improved from 40.6 to 31.5.All 12 failures had severe flexion contractures（15°）,aggravated malalignment（varus10°）,and involved tricompartment disease（mean preoperative HSS scores,23.5;mean preoperative WOMAC scores,62;mean preoperative flexion contractures,15.8°）.Conclusions： Arthroscopic debridement has really improved symptoms and good clinical outcom for knee osteoarthritis in appropriately selected patients.